In experienced hands, these are uncommon, and in most circumstances they are self-sealing and clinically inconsequential. Rarely, generalized peritonitis and abdominal wall abscess have been reported after the procedure. Most cases of intraperitoneal hemorrhage are due to coagulopathy rather than large-vessel injury.

Prevention:

Check patient's coagulation status prior to procedure

Never insert the needle through superficial veins or surgical scars, since scars may have collateral vessels or underlying adherent bowel

When inserting the needle, avoid continuous suction as this may attract bowel or omentum to the end of the paracentesis needle with resulting occlusion and greater risk of perforation

Management:

If ascitic fluid appears feculent: withdraw the needle. Observe the patient for 24 hours for signs and symptoms of peritonitis

If ascitic fluid appears bloody: withdraw the needle and choose another site of entry